Abstract
Introduction
Wound suction drains have been used to decrease the rate of post-operative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. In spine surgery, controversy is profound as on one side it decreases the rare but devastating complication of post-operative epidural hematoma, while it may have a hypothetical increase in the risk of infection. In the spine literature the incidence of epidural hematoma in the post-procedural period ranges from 0.2–2.9%, while post-operative wound infection is in the 0.7–16%, thus identifying a method that can decrease the incidence of these complications would be of uttermost benefit. To help address this debate, we conducted a systematic review discussing the use of these drains and to extensively explore the efficacy and safety of closed suction wound drainage in spine surgery in the post-operative period.
Materials and Methods
Electronic databases and reference lists of key articles were searched up through January 22nd 2015 to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group.
Results
Five heterogeneous studies, three randomized controlled trials (RCT) and two cohort studies, form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with or without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered LOW or INSUFFICIENT.
Conclusions
Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on use of closed suction wound drains in lumbar spine surgery until higher level of evidence becomes available to support its use.